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INNOVATION

INDUSTRY DEFENCE AND SECURITY AUSTRALIA LIMITED
PACIFIC 2019 YOUNG DEFENCE INNOVATOR AWARD
 
ENTRY FORM
 
1. Name, Address and Date of Birth of Nominee:
(include phone number, email and postal address)
Name:
Address:
Date of Birth:
Phone:
Email:
Postal Address:
 

2. Name and address of Nominee's Employer:
Name:
Address:
 

3. Declaration of Australian Citizenship:
 

4. Name, Job Title and Employer of Nominator: (if other than the Nominee)
(include phone number, email and postal address)
Name:
Job Title:
Employer:
Phone:
Email:
Postal Address:
 

5. Brief Description of Project on which Nominee worked:
Innovation can be described simply as something that is either new to the adopter or that changes the adopter’s circumstances and/or behaviour – and it may be a combination of all three. Please frame your description using this framework as guidance.
(Attach additional pages if necessary - marked as Annexe A)
Upload Additional Information:
   

6. Description of Nominee’s Contribution to the Project:
(attach additional pages if necessary - marked as Annexe B)
Upload Additional Information:
   

7. Description of Nominee’s Originality and Innovativeness in meeting the challenges of the project concerned:
(attach additional pages if necessary - marked as Annexe C)
Upload Additional Information:
   

8. If successful, how will the Nominee use the Scholarship to advance his/her career?

(NB – the Nominee has the right, when approached, to decline the nomination for any reason he or she may choose. Deliberately falsifying data on the entry form will result in immediate disqualification)

 

9. Name and Approval of Authorised Nominee:
Name:
Job Title:
Date:
Acceptance:   
 
 

For further information please contact:

Gregor Ferguson
Executive Manager, Industry development
Industry Defence and Security Australia Limited
PO Box 4095
GEELONG VIC 3220

Ph: 0414 803 717
Email: gferguson@amda.com.au